Medical testimony offered in trial of infant's death

Thursday

May 23, 2013 at 6:44 PMMay 23, 2013 at 6:49 PM

The People v. Keith Thibeault trial continued Thursday with two medical witnesses testifying. The session began with Chief Judge Suzanne Hoseth Kreeger reminding the jury that Keith Thibeault is not on trial for any past injuries done to Keegan or Everette Thibeault.

Mattie Cookmattie.cook@sentinel-standard.com

The People v. Keith Thibeault trial continued Thursday with two medical witnesses testifying. The session began with Chief Judge Suzanne Hoseth Kreeger reminding the jury that Keith Thibeault is not on trial for any past injuries done to Keegan or Everette Thibeault.

The first testimony was offered by Dr. Rudolph Castellani, a neuropathologist at the University of Maryland. For the purpose of the trial, Castellani was considered an expert in neuropathy.

Sparrow Lansing Hospital contacted Castellani about Everette Thibeault's case, because they wanted a consultation due to the complex nature of the brain and spinal cord issues found. Castellani's external observations included swelling of the brain, the dura contained neomembrane that was indicative of prior trauma and there were patchy subarachnoid hemorrhages, which are very common in head trauma cases. In his experience, this type of injury does not happen with minor trauma, said Castellani.

Castellani was shown a photograph of a portion of Everette's skull, and he noted that the bleeding shown was indicative of an acute, subdural hemorrhage. In addition, his examination of Everette's eyes revealed that there had been an optic nerve hemorrhage and multiple hemorrhages in the retina.

Castellani's stated his conclusion was evidence of head trauma on two occasions, which was complicated by cardiac arrest. He testified that he commonly sees subdural and retina hemorrhages in inflicted or abuse injuries, which suggests that these injuries did not occur accidentally.

According to Castellani, the cause of death was recent head trauma, which usually shows no external signs, such as bruises. In cases where head trauma is severe enough to cause death, an absence of external trauma is common in cases of inflicted death, he said.

Kevin Peterson, criminal defense attorney, cross-examined Castellani about the fall Everette took off from the couch in the weeks prior to his incident. The witness confirmed that this fall could have produced bleeding from an already-existing neomembrane. Peterson also asked whether increased pressure in the head could cause an existing neomembrane to rebleed. Castellani responded that it was possible and that it may present no symptoms.

The second witness was Dr. Steven Guertin, the director of the pediatric care center at Sparrow Lansing Hospital and a professor for Michigan State University's College of Medicine. For the purposes of this trial, he was declared an expert in pediatric critical care medicine, child abuse and general pediatrics.

Guertin was the doctor who worked with Everette when he was admitted to Sparrow Lansing Hospital in March 2012. When Everette first arrived, his body temperature was approximately 90 degrees Fahrenheit. Guertin said with his work, it eventually got into the normal range.

Guertin said he found that Everette's bleeding was located close to the spine, and that nothing other than a car accident can cause this type of injury in a child Everette's age.

Ionia County Prosecuting Attorney, Ron Schafer, inquired as to whether the rib fractures Everette had could have been caused by the fall off from the couch that Keith Thibeault reported. Guertin testified that the injuries Everette sustained would be "almost impossible" based on Keith Thibeault's explanation of events.

Guertin also explained that the retinal hemorrhaging found in this case leant itself to child abuse.

"Accidents can cause retinal hemorrhages. They're usually localized in one area... Here you see a blot, dot and flame hemorrhages. This means that more than one layer of the eye is injured which is a characteristic of child abuse," said Guertin.

Guertin explained that diffuse, multilayer hemorrhages are caused by high speed motor accidents, having one's skull crushed or child abuse.

Since Guertin's testimony was based on his examination of both Everette and his twin brother Keegan, he presented information based on Keegan's bone survey. According to Guertin, Keegan's leg had a disc of bone that was entirely broken off and was at least one week old at the time he was examined. Guertin posited that this type of injury is done by pulling hard on the foot or the ankle or shaking an infant hard enough to break off an entire disc of bone.

Peterson's cross-examination of Guertin included a discussion of external signs of injury to Everette's body. Guertin's examination found no signs of grip marks, bruising or evidence of hitting the infant.

In addition, Peterson and Guertin discussed research concerning how impacts from falls can affect the level of damage done to a child. According to Guertin, there are differences between shaking and making impact with another surface, and typically there is evidence of an impact site. Everette showed no sign of an impact site; Guertin argued that an impact site does not have to be present in order for the case to be child abuse.

The trial will be continuing at 11 a.m. on Friday and is expected to conclude by 4 p.m. The trial also will resume next week with more witnesses called to the stand to testify.

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